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Impact of long‐term care insurance on the health status of middle‐aged and older adults

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  • Jingyi Wang
  • Jing Guan
  • Guojun Wang

Abstract

With the increase of aging population, long‐term care insurance (LTCI) systems have become important for improving individuals' health. However, the effect of LTCI on health is unclear, especially in developing countries, owing to the lack of random policy shocks and comprehensive databases. This study investigates the Chinese LTCI pilot program, using four waves of the China Health and Retirement Longitudinal Study database (sample aged ≥45 years) from 2011 to 2018. The recent difference‐in‐differences approaches for staggered design, which are capable of dealing with the negative weights issue, are used to investigate changes in health status, measured by self‐rated health (SRH), (instrumental) activities of daily living, self‐rated depression, and cognition, in pilot and non‐pilot cities before and after LTCI implementation. Long‐term care insurance has a significant average effect on SRH improvement and a long‐term positive effect on cognition for middle‐aged and older populations. This study provides the first evaluation of LTCI policy on health outcomes using the recent difference‐in‐differences approaches. It provides evidence for the overall health improvement achieved through the LTCI and offers positive reinforcement and potential areas for improvement in establishing LTCI worldwide.

Suggested Citation

  • Jingyi Wang & Jing Guan & Guojun Wang, 2023. "Impact of long‐term care insurance on the health status of middle‐aged and older adults," Health Economics, John Wiley & Sons, Ltd., vol. 32(3), pages 558-573, March.
    • Handle: RePEc:wly:hlthec:v:32:y:2023:i:3:p:558-573
    DOI: 10.1002/hec.4634
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    1. Guan, Jing & Tena, J.D., 2022. "Physical activity, leisure-time, cognition and academic grades: Connections and causal effects in Chinese students," Journal of Asian Economics, Elsevier, vol. 78(C).
    2. Xiaoyan Lei & Yuqing Hu & John J. McArdle & James P. Smith & Yaohui Zhao, 2012. "Gender Differences in Cognition among Older Adults in China," Journal of Human Resources, University of Wisconsin Press, vol. 47(4), pages 951-971.
    3. David Card & Carlos Dobkin & Nicole Maestas, 2009. "Does Medicare Save Lives?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 124(2), pages 597-636.
    4. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    5. repec:ran:wpaper:774 is not listed on IDEAS
    6. Goldman, Noreen & Korenman, Sanders & Weinstein, Rachel, 1995. "Marital status and health among the elderly," Social Science & Medicine, Elsevier, vol. 40(12), pages 1717-1730, June.
    7. Bonsang, Eric, 2009. "Does informal care from children to their elderly parents substitute for formal care in Europe?," Journal of Health Economics, Elsevier, vol. 28(1), pages 143-154, January.
    8. Martin B. Hackmann, 2019. "Incentivizing Better Quality of Care: The Role of Medicaid and Competition in the Nursing Home Industry," American Economic Review, American Economic Association, vol. 109(5), pages 1684-1716, May.
    9. Harttgen, Kenneth & Vollmer, Sebastian, 2013. "Using an asset index to simulate household income," Economics Letters, Elsevier, vol. 121(2), pages 257-262.
    10. Jing Guan & J.D. Tena, 2021. "Estimating the effect of physical exercise on juveniles’ health status and subjective well-being in China," Applied Economics, Taylor & Francis Journals, vol. 53(46), pages 5385-5396, October.
    11. Wolfgang Lutz & Warren Sanderson & Sergei Scherbov, 2008. "The coming acceleration of global population ageing," Nature, Nature, vol. 451(7179), pages 716-719, February.
    12. Strauss, John & Lei, Xiaoyan & Park, Albert & Shen, Yan & Smith, James P. & Yang, Zhe & Zhao, Yaohui, 2010. "Health Outcomes and Socio-Economic Status among the Elderly in China: Evidence from the CHARLS Pilot," IZA Discussion Papers 5152, IZA Network @ LISER.
    13. Callaway, Brantly & Sant’Anna, Pedro H.C., 2021. "Difference-in-Differences with multiple time periods," Journal of Econometrics, Elsevier, vol. 225(2), pages 200-230.
    14. David W. Baker & Julie A. Gazmararian & Joseph Sudano & Marian Patterson, 2000. "The Association Between Age and Health Literacy Among Elderly Persons," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 55(6), pages 368-374.
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    Cited by:

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    6. Yang, Tianli & Zhao, Zhong, 2025. "Long-term care insurance policy and the development of elderly care enterprises in China," China Economic Review, Elsevier, vol. 94(PB).
    7. Wenze Tian & Xiaoyu Wang, 2026. "Impact of the China Healthy Cities Pilot Policy on the Level of Healthy Aging in Older Adults," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 45(1), pages 1-25, February.
    8. Lin, Lin & He, Min & Zai, Xianhua, 2025. "Evaluating the impact of long-term care insurance reform on health-related quality of life and inequality among older adults in China: A quasi-experimental analysis," Economics & Human Biology, Elsevier, vol. 58(C).
    9. Lin, Lin & He, Min & Sun, Wenkai, 2025. "Security fosters generosity: Social security protection and charitable giving," World Development, Elsevier, vol. 196(C).
    10. Tianli Yang & Zhong Zhao, 2025. "Public Long‐Term Care Insurance and Retirement Intentions of Urban Workers: Evidence From China," Health Economics, John Wiley & Sons, Ltd., vol. 34(9), pages 1537-1559, September.

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